Provider Demographics
NPI:1235490392
Name:POWELL, ARTHUR GREGORY
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:GREGORY
Last Name:POWELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8509 LITTLE RIVER TPKE
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-3602
Mailing Address - Country:US
Mailing Address - Phone:571-244-1883
Mailing Address - Fax:
Practice Address - Street 1:8509 LITTLE RIVER TPKE
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-3602
Practice Address - Country:US
Practice Address - Phone:571-244-1883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist